Insurance Watchdog Task Force Questionnaire

Purpose of this Questionnaire
The Unfair Claims Settlement Practices Database is designed to obtain credible evidence of unfair claims settlement practices by those auto insurance companies operating in California. Once we have gathered sufficient evidence, Consumer Attorneys will present it to the Department of Insurance, and potentially other law enforcement agencies including the Attorney General’s Office, for further investigation and prosecution as appropriate.

How You Can Participate - complete the online questionnaire.
Please completely fill out all of the requested information. Only those questionnaires which are completely filled out will be accepted. Accuracy is important.

Please remember that all information provided by you in this questionnaire is intended to be reviewed by various governmental agencies. These agencies may request further verification of the information provided by you on this questionnaire.

Should you have any questions or need assistance in filling out the form, please feel free to contact Mr. Scott A. Marks, Esq. of The Marks Law Firm at 818.591.3025 or Ms. Christa Haggai, Esq. of The Haggai Law Firm at 310.988.2420, Co-Chairs of CAALA’s Insurance Watchdog Committee.

Questionnaire Instructions
Please completely fill out all of the requested information. We will accept only those questionnaires that are completely filled out. Accuracy is important.

Complete Section 16 Only
for Reporting Bodily Injury Claims. If you are Reporting Only a Medical Payments Claim, Do Not Fill Out Section 16. Instead, Complete Section 17. If You are Reporting Both a Bodily Injury Claim and a Medical Payments Claim, Complete Both Sections.

In completing Sections 16 and 17, keep in mind the following:

a) under the "date" category, the month and year is sufficient;
b) under the "total costs incurred by claimant to date" category, rounding up, or down, to the closest $100.00 increment is sufficient;
c) under the "total amount of special damages" category in Section 16, please include all special damages including, without limitation, all medical expenses, ambulance expenses, care taker expenses, automobile rental expenses, past loss of income, future loss of income discounted to present cash value and any other applicable expenses. Rounding up, or down, to the closest $100.00 increment is sufficient;
d) under the "total amount of medical special damages" category in Section 17, please include all medical bills incurred by the Claimant. Rounding up, or down, to the closest $100.00 increment is sufficient; and
e) under Section 14, do not include the amount stated in pleadings as set forth in Code of Civil Procedure Section 425.11

The "Comments" section is the place for you to add any additional information which you believe is necessary for other parties to better understand whether the insurance company attempted to settle the claim for an unreasonably low amount.

Please remember that all information provided by you in this questionnaire is intended to be reviewed by various governmental agencies. These agencies may request further verification of the information provided by you on this questionnaire.

Background
Over the past decade it has become clear that certain automobile insurers maintain a general business practice of attempting to settle claims for an unreasonably low amount. In so doing, these automobile insurers routinely violate California's Fair Claims Settlement Practices Regulations, Insurance Code Section 790.03(h) and the common law.

Such misconduct by these automobile insurance carriers harms not only their policyholders, but millions of other Californians as well, by forcing everyone to spend additional money in attorney fees and costs in order to receive fair compensation for their injuries. Such unlawful conduct also places tremendous pressure on California's already overburdened  judicial system by compelling policyholders and the general public to file expensive and time consuming lawsuits, and demands for arbitration, just to get a simple claim paid by the insurance company. 

Consumer Attorneys is committed to preventing unlawful conduct by corporations and insurance companies by, among other things, assisting government agencies such as the California Department of Insurance, in the enforcement of its Regulations by providing the Department with credible information regarding the unlawful and unfair claims settlement practices of some of the automobile insurers it regulates.

Consumer Attorneys is requesting your help in developing a comprehensive database which identifies those insurance carriers that consistently violate the law by making unreasonably low settlement offers on automobile bodily injury claims and medical payment claims. Our goal is to provide credible evidence of unfair claims settlement practices by those automobile insurance companies to the California Department of Insurance, and potentially other law enforcement agencies including the Attorney General's Office, for further investigation and prosecution as appropriate.

Thank you for participating in this important effort.